Healthcare Provider Details

I. General information

NPI: 1669001137
Provider Name (Legal Business Name): SUZIE MARTIKYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 LOMITA BLVD STE 120
TORRANCE CA
90505-1907
US

IV. Provider business mailing address

11948 BURBANK BLVD APT 16
VALLEY VILLAGE CA
91607-1824
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-1092
  • Fax:
Mailing address:
  • Phone: 818-212-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: